Letters

Access to invasive procedures can be audited by ethnic group

EDITORFeder et al reported findings from the appropriateness of coronary revascularisation (ACRE) study showing that among patients deemed clinically appropriate for coronary artery bypass grafting, south Asians are less likely than white patients to undergo procedures.¹ They pointed out the lack of a mechanism to monitor ethnic differences in invasive management of coronary disease in the NHS. The quality of hospital episode statistics has improved significantly in many trusts since the ACRE study. In 1999-2000 the quality index for our local trust data on ethnic group was 92.8% compared with a national average of 65.4%.² This contrasts with a rate of invalid coding in 1995-6 of 62.9%.³

We conducted an audit of all patients admitted with unstable angina or acute myocardial infarction in a local trust between July 1999 and June 2000. Information was obtained on age, sex, ethnic group, and Carstairs socioeconomic deprivation category derived from postcode of residence. Record linkage to subsequent hospital episode statistics provided follow up information on procedures up to 18 months after admission. Data on 53 south Asians and 1556 white patients were analysed using logistic regression models.

We found higher access to angiography and coronary artery bypass grafting among south Asian compared with white patients in the univariate analysis. We found no difference in access to angiography (odds ratio=0.94, 95% confidence interval 0.49 to 1.83) or coronary artery bypass grafting (1.27, 0.62 to 2.62) between south Asian and white patients after controlling for age, sex, and Carstairs deprivation category.

Despite the small sample size, lack of control for severity, or appropriateness we have shown that access can be audited by ethnic group using routine data. Many trusts may currently have the ability to carry out such audit, especially in areas with high ethnic minority populations. It may not be long before national audit of ethnic data on access to procedures is possible.

Ibrahim I Abubakar, specialist registrar in public health. 
David Kanka, consultant in public health medicine. 
Public Health Laboratory Service Communicable Disease Surveillance Centre Eastern, Institute of Public Health, Cambridge CB2 2SR iad21{at}medschl.cam.ac.uk

1.	Feder G, Crook AM, Magee P, Banerjee S, Timmis A, Hemingway H. Ethnic differences in invasive management of coronary disease: prospective cohort study of patients undergoing angiography. BMJ 2002; 324: 511-516[Abstract/Free Full Text]. (2 March.)
2.	Department of Health. HES data quality report1999/00. www.doh.gov.uk/hes/data_quality/dqi99/rgn99.html (accessed 5 Mar 2002).
3.	Aspinall PJ. The mandatory collection of data on ethnic group of inpatients: experience of NHS trusts in England in the first reporting years. Public Health 2000; 114: 254-259[CrossRef][ISI][Medline].